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Purpose of Review <p>Aortic stenosis (AS) demonstrates marked sex-related differences in its pathophysiology, clinical presentation, and outcomes following intervention. This review aims to examine recent evidence concerning sex-based differences in the pathophysiology, clinical presentation, and outcomes of AS. We specifically address the implications of these differences for diagnostic pathways, procedural planning, and management strategies, focusing on the comparative outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in men and women.</p> Recent Findings <p>Emerging studies highlight significant sex-related disparities in AS. Compared with men, women typically present later in the disease course, often at an older age, but with fewer comorbidities, less valvular calcification, and greater fibrotic changes. Women exhibit distinct myocardial responses, characterized by concentric left ventricular remodeling and smaller ventricular cavities, and increasing procedural complexity. Short-term outcomes after TAVR are less favourable in women, marked by higher vascular complication and bleeding rates; however, long-term survival is consistently superior in women compared to men. Recent clinical trials, such as RHEIA and SMART, along with population-level registry data, have reinforced the importance of valve type selection and procedural planning in women, particularly those with small aortic annuli. These studies also underscore persistent gaps in diagnosis, referral, and treatment access for women with AS.</p> Summary <p>Gender-specific differences significantly influence the clinical trajectory and outcomes of AS treatment. Despite encountering greater procedural complexity and short-term complications, women benefit from improved long-term survival following TAVR. These observations emphasize the necessity of individualized, gender-based management strategies to optimize patient outcomes. Further research is needed to elucidate the underlying biological mechanisms driving these disparities and to refine guidelines for tailored, sex-specific therapeutic approaches in AS.</p>

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Gender Disparity in the Treatment of Aortic Stenosis

  • 期刊论文

  • 发表日期：

    2025年7月28日

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  • Abhinav Aggarwal,
  • Manoj Kumar,
  • Shaun Abid,
  • Yehya Khlidj,
  • Carlos D. Davila

摘要

Purpose of Review

Aortic stenosis (AS) demonstrates marked sex-related differences in its pathophysiology, clinical presentation, and outcomes following intervention. This review aims to examine recent evidence concerning sex-based differences in the pathophysiology, clinical presentation, and outcomes of AS. We specifically address the implications of these differences for diagnostic pathways, procedural planning, and management strategies, focusing on the comparative outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in men and women.

Recent Findings

Emerging studies highlight significant sex-related disparities in AS. Compared with men, women typically present later in the disease course, often at an older age, but with fewer comorbidities, less valvular calcification, and greater fibrotic changes. Women exhibit distinct myocardial responses, characterized by concentric left ventricular remodeling and smaller ventricular cavities, and increasing procedural complexity. Short-term outcomes after TAVR are less favourable in women, marked by higher vascular complication and bleeding rates; however, long-term survival is consistently superior in women compared to men. Recent clinical trials, such as RHEIA and SMART, along with population-level registry data, have reinforced the importance of valve type selection and procedural planning in women, particularly those with small aortic annuli. These studies also underscore persistent gaps in diagnosis, referral, and treatment access for women with AS.

Summary

Gender-specific differences significantly influence the clinical trajectory and outcomes of AS treatment. Despite encountering greater procedural complexity and short-term complications, women benefit from improved long-term survival following TAVR. These observations emphasize the necessity of individualized, gender-based management strategies to optimize patient outcomes. Further research is needed to elucidate the underlying biological mechanisms driving these disparities and to refine guidelines for tailored, sex-specific therapeutic approaches in AS.